Predictors of upper airway obstruction following extubation in critically ill children

Abstract

Upper airway obstruction after extubation is a serious complication that can lead to extubation failure and other unfavorable outcomes in children.

Objective: to describe the incidence and risk factors associated with post-extubation upper airway obstruction in critically ill children.

Patients and Method: A prospective descriptive observational study was carried out in a pediatric intensive care unit in Argentina over two years. Patients older than 1 month and younger than 18 years, receiving mechanical ventilatory support (MV) for more than 24 hours through an endotracheal tube (ETT) and with at least one programmed extubation were included.

Results: Of 260 patients, 65 (25%) developed post-extubation upper obstruction. Of them, 37 were females (56.9%), with a median age of 14 months and 10 kg weight. The PIM3 score was 2.8 and the most frequent reason for admission was acute lower respiratory infection in 38 (43.1%) patients, among whom 36 (55.4%) had at least one complex chronic condition. Twenty-seven (41.5%) failed extubation and 5 (7.7%) required tracheostomy. A multiple logistic regression analysis was performed to determine the relationship between different variables with the dependent variable. Independent risk factors explaining post-extubation upper obstruction were age ≤ 24 months and MV support for ≤ 3 days.

Conclusion: Post-extubation upper airway obstruction is frequent in the pediatric intensive care unit. We found that infants and mechanical ventilation duration less than or equal to 3 days are independent risk factors for its presentation.